Leukaemia
Leukaemia is a cancer of the white blood cells. All blood cells are made in the bone marrow, the spongy substance at the core of some bones in the body. Bone marrow contains:
- Red Blood Cells, which carry oxygen around the body
- Platelets, which help the blood to clot and control bleeding
- White Blood Cells, which help fight infection
There are two different types of white blood cells; lymphocytes and myeloid cells (including neutrophils). These white blood cells work together to fight infection. Normally, white blood cells develop, repair and reproduce themselves in an orderly and controlled way. In leukaemia, however, the process gets out of control and the cells continue to divide in the bone marrow, but do not mature. These immature dividing cells fill up the bone marrow and stop it from making healthy blood cells. As the leukaemia cells are not mature, they cannot work properly. This leads to an increased risk of infection. There are two types of leukamia in children:
Acute lymphoblastic leukaemia (ALL)
ALL is a cancer of immature lymphocytes, called lymphblasts or blast cells. There are two different types of lymphocytes: T-cells and B-cells. Often, leukaemia occurs at a very early stage in the immature lymphocytes, before they have developed into either T-cells or B-cells. However, if the cells have developed this far before becoming leukaemic, the type of leukaemia may be known as T-cell or B-cell leukaemia.
Symptoms
- Tired and lethargic because of anaemia, which is caused by a lack of
Red Blood Cells - Pale Skin
- Develop Bruises
- Unusual bleeding which may take longer to stop because of the low number of platelets present in their blood (which help blood to clot)
- Children can suffer from frequent infections because of low numbers of normal white blood cells
- Purple skin rash called petechiae
- A child is likely to feel generally unwell and may complain of aches and pains in the limbs or may have swollen lymph glands.
At first, the symptoms are just like those of a viral infection, but when they continue for more than a week or two, the diagnosis usually becomes clear.
Acute Myeloid Leukaemia
Acute myeloid leukaemia is an overproduction of immature myeloid white blood cells (blast cells). Cells that have started to show some of the features of myeloid cells are said to show differentiation. Cells that do not show signs of becoming a particular type of white blood cell are known as undifferentiated. There are different sub-types of AML, depending upon exactly which type of cell has become leukaemic, the stage of development (maturation) the cells are at and whether the cells are differentiated. Knowing the sub-type of AML is important, as it helps doctors decide on the best treatment.
Symptoms
- Tired and lethargic because of anaemia, which is caused by a lack of
Red Blood Cells - Pale Skin
- Develop Bruises
- Unusual bleeding which may take longer to stop because of the low number of platelets present in their blood (which help blood to clot)
- Children can suffer from frequent infections because of low numbers of normal white blood cells
- Children can suffer from frequent infections because of low numbers of normal white blood cells
- A child is likely to feel generally unwell and may complain of aches and pains in the limbs or may have swollen lymph glands.
At first, the symptoms are just like those of a viral infection, but when they continue for more than a week or two, the diagnosis usually becomes clear.
Brain Tumors
A tumour in the brain can come from the brain itself (primary), or from another part of the body (secondary). This information is about primary brain tumours. A growing tumour may push normal brain out of the way, or block the flow of fluid in the brain.
- Headaches (often worse in the morning)
- Vomiting (usually in the morning) or feeling sick
- Fits (seizures)
- Feeling very irritated or losing interest in day-to-day things
- Eye problems, such as abnormal eye movements, blurring or double vision feeling very tired much more quickly than usual
- Feeling extremely sleepy (drowsy) for no reason.
- Brain tumours can also cause problems with balance and walking, weakness down one side of the body, or changes in behaviour. Some of these symptoms are common even without a brain tumour, and this can cause confusion in the early stages.
Ewing Sarcoma
Sarcomas are rare types of cancer that develop in the supporting tissues of the body. There are two main types: bone sarcomas and soft tissue sarcomas. Bone sarcomas can develop in any of the bones of the skeleton, but may also develop in the soft tissue near bones. Soft tissue sarcomas can develop in muscle, fat, blood vessels or any of the other tissues that support, surround and protect the organs of the body. This type of cancer is a bone cancer and most commonly occurs in the long bones, ribs, pelvis and spine (vertebral column). Although Ewing sarcoma is a type of bone cancer, it can also occur very rarely in the soft tissues. This is called extraosseous Ewing sarcoma. Another type of Ewing sarcoma is a primitive neuroectodermal tumour (PNET). These can be found in either the bone or soft tissue.
Symptoms
Pain is the most common symptom of bone cancer. It is frequently worse at night. However, symptoms may vary depending on the position and size of the cancer. There may be some swelling in the affected area if the tumour is close to the surface of the body and it may become tender to touch. This may cause a limp if in the leg or pelvis.
Bone cancer is sometimes discovered when a bone that has been weakened by cancer breaks after the child has a minor fall or accident. Occasionally, there may be fever or weight loss..
Germ Cell Tumours
Germ cell tumours can appear at any age. They develop from cells that produce eggs or sperm so germ cell tumours can affect the ovaries or testes. However, it is possible for a germ cell tumour to develop in other parts of the body. As a baby develops during pregnancy, the cells producing eggs or sperm normally move to the ovaries or testes. However, rarely they can settle in other parts of the body where they can develop into tumours. The most common places for this to happen are the bottom of the spine (sacrococcygeal), the brain, chest, and abdomen.
Symptoms
The symptoms depend on where the tumour develops. Usually it starts with a lump that can either be felt or it causes other symptoms.
Langerhans Cell Histiocytosis
LCH is an unusual condition. It has some characteristics of cancer but, unlike almost every other cancer, it may spontaneously resolve in some patients while being life-threatening in others.
LCH is classified as a cancer and sometimes requires treatment with chemotherapy. LCH patients are therefore usually treated by children’s cancer specialists (paediatric oncologists/ haematologists). The vast majority of children will recover completely from LCH.
Langerhans refers to Dr Paul Langerhans, who first described the cells in the skin which are similar to the cells found in LCH lesions.
Histiocytosis refers to histiocytes which are cells that are part of the immune system, and are found in many parts of the body.
There are two types of histiocytes:
- Macrophage/Monocyte cells – these destroy harmful proteins, viruses and bacteria in the body
- Dendritic cells – these stimulate the immune system.
Langerhans cells are dendritic cells and are normally only found in the skin and major airways. In LCH, the abnormal dendritic cells that look similar to Langerhans cells may be found in different parts of the body, including the bone marrow, skin, lungs, liver, lymph glands, spleen and pituitary gland. When these abnormal dendritic cells accumulate in these tissues, they may cause damage.
LCH is divided into two groups:
Single-system LCH – when the disease affects only one part of the body, for example the skin or the bone
Multi-system LCH – when it affects more than one part of the body.
Symptoms
The symptoms of LCH will depend on which part of the body is affected and whether the disease is affecting more than one part of the body. The lymph glands may be enlarged, and the child may be irritable and have a poor appetite. Pain in the bone and/or swelling and lumps on the skull can occur if LCH is affecting the bone. A skin rash such as cradle cap or nappy rash may occur if the skin is affected. A discharge from the ear or hearing problems can occur if the ear is affected. The child may have breathing difficulties if LCH affects the lungs or chest. Tummy problems such as diarrhoea and liver problems including jaundice can occur if LCH affects the gut or liver. In 10–20% of patients with multi-system disease, the pituitary gland at the base of the brain is affected, causing hormonal problems.This can lead to the child passing larger amounts of urine and being very thirsty. This is called diabetes insipidus, which is different from sugar diabetes and can be well-controlled with specific medicines. Occasionally, other pituitary hormones may be affected, causing poor growth or delayed puberty, which can also be treated.
Liver Tumours
There are two main types of primary liver cancer:
- Hepatoblastoma – this usually occurs in children under five years of age.
- Hepatocellular carcinoma (HCC) – this is rarer and usually occurs in older children. HCC is commonly related to the presence of liver infection. This happens in countries where mothers commonly have hepatitis B and vaccination is not readily available at birth for their children.
Children who are infected with hepatitis B have a higher risk of developing HCC in late childhood than uninfected children.
Symptoms
The most common symptom is a lump or swelling in the abdomen, which can be painful. Other possible symptoms include weight loss, a loss of appetite, feeling sick (nausea) and being sick (vomiting).The most common symptom is a lump or swelling in the abdomen, which can be painful. Other possible symptoms include weight loss, a loss of appetite, feeling sick (nausea) and being sick (vomiting).
Lymphoma
The lymphatic system is part of your immune system, your body’s natural defence against infection and disease. The lymphatic system is made up of the bone marrow, thymus, spleen, and lymph nodes (or lymph glands). Lymph nodes are connected by a network of tiny lymphatic vessels that contain lymph fluid. Lymphomas can start anywhere in the lymphatic system such as the neck, above the collar bone, armpit, groin and inside the chest. Glands can swell in these areas as part of the body’s response to infection, not just cancer, which is why a biopsy is needed to diagnose lymphoma.
Hodgkin Lymphoma
Hodgkin lymphoma is a type of cancer that occurs in the lymphatic system. There are two main types of Hodgkin lymphoma: classical Hodgkin lymphoma, which affects 95% of patients, and Lymphocyte Predominent Hodgkin Lymphoma (LPHL), which only affects 5% of patients. This information is about classical Hodgkin lymphoma, but it includes a short section about LPHL.
Symptoms
The first sign of Hodgkin lymphoma is usually a painless swelling of one gland, or a group of lymph glands, which continues for some weeks or even months. The first glands that are likely to be affected are in the neck or above the collarbone, most often only on one side. However, it’s important to remember that children’s glands can also become swollen when they have a common infection that causes a sore throat or a cold.
If glands in the chest are affected, this can cause a cough or breathlessness. This is caused by the pressure the glands exert onthe airways.
Sometimes, a child with Hodgkin lymphoma may have a high temperature (fever), night sweats, weight loss or itchy skin
Neuroblastoma
Neuroblastoma develops from the cells left behind from a baby’s development in the womb. The cells that it develops from are called neuroblasts.
‘Neuro’ means nerve
‘Blast’ means cells in early development
‘Oma’ means a group of cells, or a tumour
Neuroblastoma can occur anywhere in the body. The site of origin is either in one of the two adrenal glands situated in the abdomen (tummy) or in nerve tissue that runs alongside the spinal cord, in the neck, chest, abdomen or pelvis. The adrenal glands are specialised glands that are found above the right and left kidney. The adrenal glands normally release hormones to maintain blood pressure, and enable us to respond to stress. In some cases, neuroblastoma can spread to tissues beyond the original site such as the bone marrow, bone, lymph nodes, liver, and skin
Symptoms
The symptoms vary, depending on where your child’s neuroblastoma tumour is.
If the tumour is in the abdomen, your child’s tummy may be swollen and they may complain of constipation or have difficulty passing urine.
If the tumour affects the chest area, your child may be breathless and have difficulty swallowing.
If the tumour occurs in the neck, it’s often visible as a lump and occasionally affects breathing and swallowing.
Occasionally, there are deposits of neuroblastoma in the skin that appear as small, blue-coloured lumps.
If the tumour is pressing on the spinal cord, children may have weakness in the legs and walk unsteadily. If your child is not yet walking, you may notice reduced leg movements. They may also have constipation or difficulty passing urine.
Your child may be found to have high blood pressure.
Very rarely, children may have jerky eye and muscle movements, and general unsteadiness associated with the neuroblastoma.
There are often vague and non-specific associated symptoms of tiredness, pallor, loss of appetite, weight loss, bone pain and generalised discomfort.
Osteosarcoma
Osteosarcoma often starts at the end of the long bones, where new bone tissue forms as a young person grows. Any bone in the body can be affected, but the most common sites are in the arms and legs, particularly around the knee and shoulder joints.
There are several different types of osteosarcoma. Most occur in the centre of the bone. There are also rare subtypes, such as parosteal, periosteal, telangiectatic, and small cell osteosarcoma.
Symptoms
Pain in the affected bone is the most common symptom. This pain may initially come and go, and then gradually become more severe and constant especially at night. There may also be swelling around the affected bone.
Osteosarcoma is sometimes discovered when a bone that has been weakened by cancer breaks after the person has had a minor fall or accident. Some patients may develop a limp if the tumour is in the leg or pelvis. These symptoms can be caused by many things other than cancer. However, any persistent bone pain should be checked by your child’s doctor. Symptoms are often attributed to a sporting injury.
Rare Tumours
Rare cancers in children make up fewer than 1 in 30 of all childhood cancers and can broadly be grouped as:
Rare cancers that only affect children, such as pancreatoblastoma, malignant rhabdoid tumours and melanotic neuroectodermal tumours of infancy cancers that usually only affect adults, such as cancers of the digestive system, the thyroid and the adrenal gland.
Rare cancers in the head and neck area, such as nasopharyngeal cancer
rare hormonal/endocrine cancers, such as phaeochromocytoma
rare brain tumours, such as meningioma
rare skin cancers, such as melanomas.
Retinoblastoma
Retinoblastoma is an uncommon eye cancer that usually affects children under five, although it can affect children of any age. Treatment is very effective and nearly all (98 out of 100) children with retinoblastoma are cured.
Retinoblastoma develops in the light-sensitive lining of the eye (called the retina).
There are two forms of retinoblastoma:
A heritable form – this is genetic or inherited. There are often tumours in both eyes (bilateral) or sometimes only in one eye.
A non-heritable form – this is not passed on in the family. There is one tumour in only one eye (unilateral).
Symptoms
In some children with a family history of retinoblastoma, it is picked up by screening before they have any symptoms.
If there’s no family history of retinoblastoma, the first sign of the condition is often a white pupil that does not reflect light (leucocoria). This may be picked up when a picture of your child is taken using flash photography. The pupil of the affected eye may look white in the photograph (see below).
Some children may have a squint or, if the tumour is large, they may have a painful eye.
Rhabdomyosarcoma
Rhabdomyosarcoma is a type of soft tissue sarcoma (tumour). It is more common in boys than girls.
Sarcomas are rare types of tumour that develop in the supporting tissues of the body, such as bone, muscle or cartilage. There are two main types of sarcomas:
- Soft tissue sarcomas can develop in muscle, fat, blood vessels, or in any of the other tissues that support, surround and protect the organs of the body.
- Bone sarcomas can develop in any of the bones of the skeleton
- Rhabdomyosarcoma is the most common of soft tissue sarcomas in children. These tumours develop from muscle or fibrous tissue and can grow in any part of the body.
The most common areas of the body to be affected are around the head and neck, bladder, testes, womb, or vagina.
Sometimes tumours are also found in a limb, in the chest or in the abdominal wall. If the tumour is in the head or neck area, it can occasionally spread into the brain or the fluid around the spinal cord.
Symptoms
The most common symptom is a lump or swelling. Other symptoms will depend on the part of the body that’s affected by the rhabdomyosarcoma:
A tumour in the head or neck area can sometimes cause a blockage (obstruction) and discharge from the nose or throat. Occasionally, an eye may appear swollen and protruding.
A tumour in the abdomen (tummy) can cause pain or discomfort in the abdomen and difficulty going to the toilet (constipation).
A tumour in the bladder may cause symptoms such as blood in the urine and difficulty passing urine.
Wims’ Tumour
It is named after Dr Max Wilms, who first described this type of cancer. It is thought to develop from immature cells in the embryo. These cells are involved in the development of the child’s kidneys while they are in the womb. The cells usually disappear at birth, but in many children with Wilms’ tumour, clusters of primitive kidney cells, called ‘nephrogenic rests’ can still be found.
Symptoms
The most common symptom is a swollen abdomen, which is usually painless. Sometimes a parent or carer may feel a lump in the abdomen which can be quite large.
Occasionally, the tumour may bleed slightly and this can irritate the kidney and may be painful. There may be blood in your child’s urine, or their blood pressure may be raised. The child may also have a high temperature (fever), upset stomach, weight loss or a lack of appetite.
